blog for Nicola Fawcett, Medic and researcher at the University of Oxford: @drnjfawcett Views my own.

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This great Christmas BMJ article considers whether portrayal of general practice in Peppa Pig raises patient expectation and encourages inappropriate use of primary care services.

In the spirit of the article, I would like to suggest an improved Peppa Pig episode that could be used to convey more realistic expectations, encourage safe self-management and use primary care services more effectively .

Previously : Case study 2: George catches a cold (quoted in the article)

Parents call Dr Brown Bear on a Saturday regarding an 18 month old piglet with a 2 minute history of coryzal symptoms after playing outside without his rain hat.

Dr Brown Bear telephone triages and makes an urgent home visit.

After examining the throat, he diagnoses an upper respiratory tract infection and advises bed rest and warm milk. Symptoms resolve within 12 hours.

New : George catches a cold (more realistic suggestion )

George Pig has a fever and is grumpy as hell. Mummy Pig knows the score from previous experience. She checks the NHS website just to be sure, and notes George has none of the concerning signs that would suggest she needs to seek further medical advice.

She goes to the local pharmacy and has a constructive conversation with the pharmacist, and is given some pink medicine for George Pig. She goes home and attempts to syringe some pink medicine into George Pig’s mouth until roughly equal quantities of medicine have gone into George, on the carpet and in Mummy Pig’s face. George Pig is eventually only placated by bottle and daddy’s smartphone, and doesn’t want to sleep for more than 20 minutes at a time unless he is in Mummy Pig’s arms and being rocked.

I like to hear little radio reports from planet phage every now and then, as I do get asked about them quite a lot when talking antibiotic apocalypses.

It’s well worth a read for those who want a quick insight, as it’s like a microcosm of the phage therapy world all in one patient – all the hopes, limitations, concerns, all in a very nicely written article.

Clever science? tick. Phages being inactivated by the patient’s own body? tick. Development of resistance by the bacteria? tick. But also… possible clinical effect in someone with few options, and an excellent discussion about synergy between phages and antibiotics, Which I think boils down to ‘if you hit it with enough things simultaneously it goes down eventually’.

Someone on twitter suggested that if we described the threat of antibiotic resistance in terms of Game of Thrones, it might be easier to grab attention and understand. I mean, it’s all in the news about how resistant superbugs are going to kill us all…

So here we go: (Massive spoilers for GoT warning)

White Walkers = near-unkillable superbugs

So for a long time, bad guys could be killed with sharp, pointy things, and heavy, smashy things. Like bacteria can be killed with antibiotics. Only some people/things/bugs have managed to change and can no longer be killed by sharpness or smashing or even the strongest antibiotics. This is bad. Modern life sort of depends on us being able to kill things that want to kill us. If we can’t, it’s a bit of a game over, really.

But right now, they seem like they’re a long way away, and they only affect wildlings/ other people you don’t really care about but read about in the Daily Mail.

“It is hard not to feel a sense of awe of the ingenuity of the bacterial machine in surviving human intervention, as you see it revealed in DNA sequencing; findings that are beautiful in their science, and often deeply concerning in their potential consequences.”

How Whole Genome Sequencing technology is helping us understand and respond to antimicrobial resistance – our article for Angle Journal is available here:

When I talk to my hospital colleagues, and my patients, about antibiotics, overuse, and resistance, there is certainly no lack of awareness. Unprompted I frequently get told exactly what the problem is.

There’s one answer I rarely get.

“I’m probably part of the problem, and I am changing what I am doing, to do my bit”.

I get asked this quite a lot, when I talk about antibiotics, gut bacteria, and our own microbial community, or ‘microbiome’, in general.

So first up, let’s just say, I love Microbiomes. I think the whole area is fascinating, I’m lucky enough to work in the area, and I firmly believe a better understanding will transform how we see health, and how we treat our patients.

I think…we’re not quite there yet.

As I’ve heard it described many times, Microbiome science is generally still in the ‘cataloguing’ stage. We’ve just been given the tools for the first time to go and explore these incredibly complex ecosystems, previously hidden from our eyes. And we’re going into Amazon rainforest, Appalachian plains, and snowy mountains, and we’re cataloguing and counting everything we find there. It’s a wonderfully exciting time.

We’re finding that some people have incredibly diverse guts, full of rarely-seen species – (Amazon rainforest guts) – and others maybe have guts more like Siberian tundra – more sparse, fewer different species (that we can see).

Some scientists are finding they can correlate the presence of certain species with health conditions. You might say guts of patients with diabetes are less likely to contain oak trees, or guts of obese patients have far more monkeys than ants, compared to those of normal bodyweight. Great. This is all interesting stuff.